Nasal spray addiction

Nasal spray is great stuff, but there's a real risk of rebound congestion, as I've written before. Check out this NYT article about people with a real problem:
Though it is not entirely clear why, the blood vessels in the nasal lining quickly become tolerant to the drugs' shrinking effects. With months of overuse, the sprays choke off blood flow to the nasal membranes and damage them. In some patients with severe cases, Dr. Bhattaharyya said, "the inside of their nose looks like a chemical burn."

Dr. Goldstein said he had seen patients with holes in the nasal septum -- the structure that separates the two breathing passages -- from abuse of the decongestants.


Simply stopping cold turkey will usually defuse the rebound cycle in a week or two, Dr. Goldstein said, but a lot of patients cannot resist the urge to spray in the meantime.

"What I do in such cases," he said, "is insist that they stop the nasal spray and put them on a five-day course of an oral steroid like prednisone" that will usually relieve the stuffiness until the rebound is gone.

"I always tell them, 'Don't start the steroids if it's a work week,' " he said. " 'Give me a time when you can get by without getting much sleep' " because of the lingering congestion.

And, sounding like an addiction counselor, Dr. Goldstein adds, "Make sure you throw out every nasal spray decongestant you have, or you won't be able to stop using it."

Prednisone, huh? You think rebound congestion is bad, check out the warnings and contraindications on this bad boy. Don't get me wrong, prednisone is reasonably safe if used for only a short period of time, but that's true of nasal spray too. The difference here is that since prednisone is prescription only, the doctor's self control can substitute for yours.